Clinical Presentation, Imaging Features, and Management of Morel-Lavallee Lesions: A Scoping Review

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BACKGROUND: Morel-Lavallee lesions (MLLs) are rare closed soft tissue degloving injuries caused by shearing forces that separate skin and subcutaneous tissue from underlying fascia. These injuries may be underrecognized in polytrauma patients, increasing the risk of delayed diagnosis, infection, prolonged healing, and long-term morbidity. This scoping review aims to provide a comprehensive summary of clinical presentation, imaging features, and evolving management for MLLs, with the goal of identifying gaps in the literature and guiding clinical decision making. METHODS: We systematically searched PubMed, Scopus, Web of Science, Cochrane CENTRAL, and ClinicalTrials.gov between 1992 and 2025 for studies pertaining to adult patients with MLLs. Four independent reviewers screened full texts for inclusion. Data were extracted and summarized using narrative synthesis. Of 633 unique articles, 102 underwent full-text review, and 69 studies met inclusion/exclusion criteria. RESULTS: MLLs commonly present with fluctuance, ecchymosis, swelling, and skin hypermobility. Diagnosis is clinical, with imaging playing a supportive role. Computed tomography and ultrasound can aid diagnosis in acute trauma settings, while magnetic resonance imaging is best for evaluating composition, chronicity, and extent. Management strategies vary based on size, chronicity, and anatomic locations. Acute lesions may be managed with compression or aspiration. Chronic or recurrent MLLs often require sclerodesis, minimally invasive debridement, or open surgical excision, often with subsequent soft tissue reconstruction. CONCLUSIONS: MLLs remain a diagnostic and therapeutic challenge in trauma. Given the heterogeneity of existing evidence, high-quality prospective studies are needed to establish evidence-based optimal management guidelines and improve long-term outcomes.

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